Clinical Program Manager, Quality Improvement, Senior at Blue Shield of CA in El Segundo, California

Job Description:

Job Summary

 

The Clinical Program Manager, Quality Improvement is responsible for the development and execution of targeted, quality improvement initiatives in support of the Medi-Cal line of business.  This includes the design and development of contract language, pilots, toolkits and spread plans.  The incumbent also has accountability for aligning quality improvement initiatives with other lines of business (PPO, Medicare) and for ensuring that current and future QI programs align with long-term organizational strategies.

 

In a results-oriented environment, the clinical program manager will execute data improvement efforts, incentive strategies and new improvement tactics to bring additional value to integrated health benefits.  To do this, the Clinical Program Manager is expected to coordinate with internal, cross-functional matrix teams, as well as with clinical leadership and staff in provider organizations.  The Clinical Program Manager will be responsible for participating in project teams and working with external vendors, assigning and monitoring work of team members and providing guidance and leadership to ensure timely execution of deliverables. This position may include limited accountability for managing budgets. 

 

In partnership with the Medi-Cal team, the Clinical Program Manager will also be accountable for building strong, collaborative relationships with targeted provider organizations.   The Clinical Program Manager is responsible for developing and managing communications about BSC’s quality improvement initiatives, through the development of RFI responses, Medi-Cal contracts, toolkits and other adhoc assignments.  Additionally, this position organizes interdepartmental activities and has some operational responsibilities.

 

Responsibilities

• Responsible for planning, execution and evaluation of large and complex program initiatives to improve quality performance in the Medi-Cal line of business.


• Develops and monitors measurement strategies for large change and improvement initiatives.


• Manages program(s) from initiation/pilot phase through delivery/spread and monitors for continuous improvement.


• As part of a broader QI team, influences the business unit, strategies and objectives.


• Becomes an expert in company quality initiatives, as well as the products, functions, marketing and/or service policies and procedures that support those initiatives.


• Serves as a quality expert with internal constituents to drive successful improvement initiatives in the Medi-Cal line of business.


• Educates and works with external partners and participating practices as needed to identify innovation opportunities and adopt improvement actions


• Exercises independent judgment in developing methods, techniques and evaluation criterion for obtaining results.


• May assist in the planning and direction of budgets.


• May act as the business unit liaison to corporate initiatives and projects.

Nature of Supervision

• Provides guidance and leadership to and may supervise project consultants.


• Ensures various team members provide high quality and cost effective services.


• Demonstrates ability to work with and influence team members functioning in a matrix environment.


• Demonstrates thought leadership, excellent project management skills, knowledge and experience with program evaluation and consulting skills.

 

 

Knowledge, Experience and Education

• Registered Nurse (RN, LVN, BSN), PA or Master’s degree (MPH, MHA, MSW) preferred; or equivalent experience.


• At least 3 years of experience or equivalent combination of experience and education.


• At least 3 years of healthcare experience in Quality Improvement and Quality Management.


• Experience with quality improvement/process improvement techniques required.


• Knowledge of HEDIS and accrediting body requirements (i.e.; NCQA or URAC) desired.


• Previous project/program management experience required.


• Experience in the CA delegated model or with highly integrated clinical delivery systems preferred.


• High Integrity/Ethics/Trust.


• Strong ability to drive for results.


• Strong facilitator with demonstrated excellence in driving multi-disciplinary and cross-functional teams to consensus.


• Demonstrated ability to influence in a healthcare environment.


• Seasoned Critical Thinking.


• Ability to manage large, complex projects.


• Communication – the ability to summarize complex information succinctly, using QI methodology as a guide.


• Experienced in Change Management Processes, including Improvements and Redesign.


• Skilled at facilitating and growing Collaboration and Motivation amongst geographically disperse teams.


• Strong Interpersonal Skills  and demonstrated ability to build relationships in fast-paced environments.


• Financial/Quantitative Acumen.

Additional Information

• About Company: Looking for a chance to do meaningful work that touches millions? Come join the hardest working, nonprofit health plan in California and help us shape the future of health care. Blue Shield of California is focused on transforming health care by making it more accessible, affordable and customer-centric. Being a mission-driven organization means we do much more than serve our 3.5 million members: we were the first health plan in the nation to limit our annual net income to 2 percent of revenue and return the difference to our customers and the community, and since 2005 we have contributed more than million to the Blue Shield of California Foundation to improve community health and end domestic violence. We also believe that a healthier California begins with our employees, so we provide them with resources to develop and maintain a healthy lifestyle through our award-winning wellness program, Wellvolution. We're hiring smart thinkers and doers who want to work for a leader and innovator in the challenging, ever-changing healthcare space. Come and help us make health care better for everyone.










• Physical Requirements: Office Environment - roles involving part to full time schedule in Office Environment. Based in our physical offices and work from home office/deskwork - Activity level: Sedentary, frequency most of work day.
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• EEO Footer: External hires must pass a background check/drug screen. Qualified applicants with arrest records and/or conviction records will be considered for employment in a manner consistent with Federal, State and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regards to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or disability status and any other classification protected by Federal, State and local laws.











• Requisition ID: 20002PH













• Posting Date: Jan 26, 2021











• Schedule: Full-time

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